Introduction:

Aging of the breast is characterized by ptosis or descent of the breast parenchyma below the infra-mammary fold, loss of tissue elasticity and volume depletion in the upper pole. Surgical rejuvenation by simultaneous breast augmentation and mastopexy is noted as being one of the most frequently litigated interventions in aesthetic surgery with reported complication and revision rates of 17.4% and 8.7% respectively. One stage augmentation/mastopexy is routinely performed using a peri-areolar, vertical short scar or wise pattern dermo- cutaneous resection. Augmentation is achieved simultaneously by placing a silicone prosthesis in the sub-glandular or retro-pectoral plane. In one of the largest reported, consecutive cohorts, we discuss our criteria for patient selection, highlight technical aspects of the procedure, revision and complication rates and report on aesthetic outcome as well as patient satisfaction.

Method:

Patients were accrued retrospectively from a single practice between January 2004 and December 2006. Exclusion criteria were prior breast surgery, significant chest wall or breast asymmetry and staged or revisional procedures. Data collated included patient demographics, anthropomorphic measurements, choice and positioning of the implant. Aesthetic outcome was assessed by independent, blinded observers and patients satisfaction scores using a validated assessment tool. Secondary endpoints recorded included complication and revisional surgery rates.

Results (provisional):

A total of 23 patients were identified who underwent primary bilateral augmentation. Mean age 36yrs (range 21 – 59 years); 14 patients (>60%) presented with grade 2 or worse ptosis; 19 patients (80%) had PIP silicone, high profile implants positioned in the sub- glandular plane; and 17 out of 23 patients underwent a wise pattern dermo- glandular excision mastopexy. Complication and surgical revision rates are currently pending. Validated outcomes i.e. the aesthetic rating scale and patient satisfaction score are also pending. Anecdotally there however appears to be no discernable difference in this cohort's outcomes from earlier staged procedures or indeed the independent mastopexy or augmentation interventions.

Conclusion:

We believe the provisional outcomes from this cohort supports the contention that in selected patients, primary simultaneous augmentation with mastopexy gives good aesthetic results with complication and revision rates well within the limits accepted for the separate interventions. The population size and mean follow-up time are limiting factors in this study.